Joint Attention For Children With Autism

ByLondon Speech and Feeding
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Kids Speech Therapist London

Why is joint engagement important for communication development?

It has been well-documented that the development of joint attention is impaired in children who have social communication difficulties or autism. It is, in fact, this impairment which distinguishes children with ASD from children who have other developmental delays.

A lack of joint attention in very young children is an early sign of autism as it is a signal that there is a disruption in the motivation to connect socially with others. Since this is a crucial element, I thought I would outline what we mean by Joint Attention as supported by the research undertaken at Hanen.org.

In typically developing children, the ability to shift attention between a person and an object for the purposes of connecting socially or for requesting develops around the same time. However, for children with ASD, these components emerge one at a time and in a linear fashion. Children with ASD usually start with requesting something and later they may learn to share attention for social sharing. (see pattern below as a general guide).

As with typical development, there is variation in the order that these skills emerge but the following patterns of development is commonly seen:

  • Reaching, taking adult’s arm/hand or pointing to ask for something — but without looking at the adult
  • Gradually alternating looking between person and object of desire
  • Then learning to follow the point of another — which is responding to joint attention initiated by another
  • Directing attention to share interests — without looking at the adult: pointing to a truck on the road/ helicopter circling above
  • Then directing attention to share interest by alternating gaze shift between person and object — here the child is now initiating joint attention.

What is important to note is that in order to fulfil the criteria for true joint attention, the purpose of directing the attention of another person must be social in nature. In other words, it must not be exclusively to obtain a desirable object or event/action. True Joint Attention is seen verbally or non-verbally; we want to share a thought with another person and direct them to something we are interested or excited or spooked by.

For example: we can see an amazing firework display in the distance and we want to quickly direct our friend’s attention to this. In order to do this we might be tugging their sleeve/arm whilst pointing to the display in the distance, and perhaps we might add “wow look over there!” We are doing so simply to share an interest without obtaining anything, we are just being social with each other. So True Joint Attention is not just looking at what we want to have, then look at the person who can get this for us and then point to the item. We can say that this is the precursor to true joint attention, which is purely social in nature.

Because true joint attention is an essential precursor to typical language development, the absence of joint attention in children with ASD contributes to difficulties with language learning. Beuker, K., Rommelse, N., Donders, R. & Buitelaar, J. (2013).

The Hanen programme for Parent Child Interaction teaches parents of children with Social Communication Difficulties step by step how to enable their children to learn to pay attention to an object and the parent at the same time.

We learn how to enable a child to:

  • engage take turns
  • shift eye gaze between toy and adult
  • copy adult’s actions, gestures and then words
  • play with toys in different, new ways
  • interact and for longer periods of time
  • have fun whilst playing

If you would like to know more about the Hanen programme please get in touch. I look forward to exploring the topic with you and help guide you forward if this is something your child is struggling with.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Speech sounds: Expectations vs reality
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Speech sounds: Expectations vs reality

ByLondon Speech and Feeding

Sometimes our kids find it hard to listen to sounds in words and hearing the difference between sounds. This is an important skill which we call “sound awareness”. A lack of it can really impact on clear speech sounds production.

Your child might be confusing similar sounding words. Or they might not notice that a TAT is not a CAT for a DOD is not a DOG. Often children with speech sound disorders or difficulties don’t tune into individual sounds or even syllables. Grow your knowledge to support your child.

Read our latest blog on hearing the difference between sounds to develop speech sound production.

Practice makes perfect

There is a lot more to speech sound production than first meets the eye. Did you know that producing the correct speech sound at sentence level is the last piece to the communication puzzle? There’s a lot of practice before your child develops this last stage of speaking clearly. Your Speech and Language Therapist will start by determining if your child can hear the difference between the sound they are producing and the correct sound. So if your child says LIT instead of LICK we might contrast those two words by perhaps using a candle and a lollypop. Each time he/she says LICK they get to have a lick (or 3) on the lolly. But if they say LIT then we light up and blow out a candle. This way your child can see that there is a difference between those words and that the sounds we make actually matter. Fancy that!!

We call this auditory awareness, which is essentially hearing the sounds in words. Don’t be surprised if you hear your child’s therapist model the sound a lot. This is to develop their awareness. The more your child hears a sound, the easier they will find production. Furthermore, your Speech and Language Therapist will work on phonemic awareness (sound structures) such as the difference between a sound (e.g. sh, is one sound) vs a syllable (e.g., shell has one syllable) vs total number of sounds in a word (shell has three sounds sh-e-ll ), like you can see in my little video clip.

Once a child is able to produce a sound on its own and they can hear and identify how a short word is said correctly we can go and repeat lots of similar words with the sound at the beginning or end until it becomes automatic and new neuro pathways are laid in the child’s brain. From there we branch out into short phrases and then eventually sentences.

Six tips to practise auditory discrimination for speech sound production

  1. Sit opposite your child so they can see your mouth or or sit next to the child and place a mirror in front of you so they can see and hear your production.
  2. Make it fun! Once they’ve identified the sounds in the word, play part of a game (e.g., pop up pirate, Jenga, something which allows plenty of turns).
  3. Use car journeys or walking to school to practise (e.g., oh I see a sheep, sh-ee-p, sh-ee-p has three sounds. Can you spot something beginning with /sh/?)
  4. Remember that spellings can differ (e.g., ‘chef’ and ‘shed’ both have the same initial sound).
  5. Talk about what you’re doing with your mouth (e.g., my lips are rounded for /sh/). Your Speech and Language Therapist will be able to support you with this.
  6. Make silly sentences using your child’s special sound (e.g., Sheep show shepherds shearing).

At this stage you are not expecting your child to produce the sound. This is why it’s important that they continually hear an excellent model. If your child attempts speech sound production at any stage, this is to be encouraged as it’s a great opportunity to model the correct version.

Contact me to develop your child’s speech sounds.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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A day in my life as an Independent Speech and Language Therapist

A day in my life as an Independent Speech and Language Therapist

ByLondon Speech and Feeding

During the pandemic I wrote a blog on what my working day looked like. Now a good year has passed since coming back to some sort of normality and I thought I would update this ‘day in the life of an SLT’ as my working life has changed of course to reflect the ‘new normal’.

I have become truly busy, perhaps busier than I have ever been to be honest. It’s probably mostly due to the fact that I do most of the aspects of my work myself — though I want to mention two invaluable people here without whom I could not function as well as I do: the excellent Nathalie Mahieu () helps me with my SEO, Insta posts and blog uploading and the wonderful Sue Bainbridge () makes sure that my accounts don’t get into trouble with His Majesty’s tax office.

Attached to our role as Speech and Language Therapists is an arguably enormous amount of administration/paperwork and preparation required for each and every client. This needs to be factored in when deciding how many families I can realistically see each working day. For me it works out as typically 3–5 clients a day, Monday to Friday.

So how does my day typically look? Each day varies a lot depending on what type of client I have, but on average it looks a bit like this:

First thing in the morning — after having a coffee and a quick check-in with my besties on WhatsApp — I do my Buddhist chanting for about an hour. My Buddhist prayers are the base of all I do and get me connected to my higher purpose and how to create value with each activity and each person I see that day. It sets me up for the day, I keep in mind who is going to come and see me and how I can best help them.

Next up, I do the daily ‘spring-clean’ of my therapy room (on all fours! no joke ???? those kids see every speck!), vacuum the floors, wipe down the toys with flash-wipes and tidy up all my boxes, making sure that the battery toys are working, and everything else is in place. On to the guest toilet, the hallway needs to be rid of all the men’s shoes and trainers and coats… It’s endless what needs tidying when you are living with three men… This takes about 45 minutes.

An articulation activity – packaging practice into a little game

Then I prep for all my clients that day. I have now got so much quicker about selecting therapy materials. For one thing I have purchased so many toys and materials over the past five years that I can literally now open a shop and need to consider building an extension! ???? The upside is that it is now very easy for me to select a good handful of toys or games for any one child, even at a minute’s notice. Though, on average, I spend about 30 minutes per child preparing activities.

Hurrah, it’s 11 am and my first client of the day arrives and the fun begins.

When they leave around an hour later, the cleaning and wiping down starts again, this time less extensively. I write up my notes and send homework whilst enjoying a cuppa.

The next client comes at 12.30 pm and once they have left, floor cleaned, toys wiped, notes written it is time for a quick lunch. No more than half an hour usually.

Afternoon clients tend to be one more little one (nursery age) at 2.15 pm and thereafter I see mostly older school children for a variety of reasons (mainly speech production but also some language-based activities). I tend to say farewell to my last client of the day around 6 pm. I spend another hour, sometimes more, on writing up notes, answering new enquiries, blogging and phone calls to keep my service fresh, inspirational and exciting.

And then dinner and the rest of the day rushes by. I tend to finish my day with some more Buddhist chanting, not a lot, perhaps 10–20 minutes to reflect on what has gone well and what could have been better — re-determine to improve or make better as needed.

Tele therapy activity using online materials plus a coreboard

In terms of where I provide a service, I still do a good mix of online clients (tele-therapy) and in-person clients in my clinic, which I love. Occasionally, I visit children in their nursery or at home but this service is now only available for long-standing clients.

Each client is hand-picked to make sure that we are a good fit: no one client gets the same treatment as another; each client is unique, we get to know one another well over the time we work together and they are always highly valued. That takes time and, in reality, each client gets about two hours of my time. That is the actual session plus all the preparation and aftercare, i.e., bespoke hand holding, tweaks, problem solving and reassurance in between sessions.

I absolutely love this way of working and would not ever want to do anything else. Nearly three decades of working both in the NHS and in private practice, countless courses (continual professional development) have enabled me to flourish as a therapist and I know that I offer something special and very valuable to my clients.

My unique way of working affords all my lovely clients the help they need to support their children to make progress; and it gives me the right balance of job satisfaction and work life balance for now. My lovely reviews and testimonials tell me that my clients appreciate my service and this at the end of the day is the most important.

If you are interested in exploring Buddhism/buddhist chanting then check out this link (https://sgi-uk.org/), and feel free to contact me about that specifically, regardless of whether you want speech therapy. I am always happy to chat about Buddhism, it has been so enriching for the last 43 years of my life.

If you need help with your child, please do not hesitate to contact me.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Learn to Use the ‘OWL’ Strategy to Improve your Child’s Speech, Language and Communication

Learn to Use the ‘OWL’ Strategy to Improve your Child’s Speech, Language and Communication

ByLondon Speech and Feeding
Speech Therpaist in London

You have heard strategies from so many different people, you are confused by which you should use with your child. You’ve ended up not using any strategies to support speech and language development because you don’t know where to start. Let me ease your overwhelm and take you through the Observe, Wait and Listen (OWL) strategy, which you can use with any child of any age.

Our goal is to allow children to engage with us, to have that moment of 1:1 shared experience, a moment of curiosity, a moment you can share together. The OWL strategy aims to provide exactly that! The use of ‘observe, wait and listen’ generates spontaneity. After all, we want our children to be able to communicate in all different environments, in a way that is appropriate for different situations and not just the therapy setting.

The OWL strategy

The OWL strategy allows you to gain a connection with your child. But you might be left wondering what each of the stages mean. Let’s explore this further.

Observe: You observe your child carefully, paying close attention to what they say or do.

Wait: You wait. This allows your child time to initiate an interaction or show an interest. Waiting is more difficult than you think. Try practicing this technique for 5-10 seconds. It’s surprising how long it is. Remember silence is golden!

Listen: Listen to your child and respond appropriately. This is instead of thinking about what you are going to say next.

One of my top tips is to choose a time in the day to practice the OWL strategy. This could be as little as 3 minutes in the day. Little and often is best practice for success.

Alongside the OWL strategy, you can copy what your child is doing with respect and enthusiasm. The most important thing to take away from this blog is that you’re making no demands on your child and that it’s all about having fun on a regular basis! Start using the OWL strategy today, it’s never too late to begin!

Contact me to find out more about the OWL strategy.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

Some ideas to encourage communication
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Some ideas to encourage communication

ByLondon Speech and Feeding

Coming up with ideas for supporting your child’s speech, language and communication can be difficult especially during the holidays. All these activities are easy to implement and can be adapted to your child’s age and stage of development.

Some activities to support your family through the summer:

1. Create a story book / photo book of what you’ve been up to over the holidays

Collect photos of everyday activities and stick them into a file. You can print them out or you could just look at them on your phone or tablet. Create good little sentences or words / phrases for each picture: yummy ice cream / eating pizza / digging the sand / a sandcastle with mum.

This enables your child to develop

  • their attention and listening
  • sequencing of events
  • expressive language (talking)
  • and conversational skills.

2. Explore the outside world (e.g., water the flowers, dig in the soil)

Depending on your child’s language level keep it very simple: single words or short phrases. Or you could practise concepts such as ‘pronouns’: he is eating an ice cream / we are splashing in the pool / she is riding a bike.

3. Splashing in a paddling pool

This is a great activity to build attention. You can call “splash, splash, splash”, “ready steady go splish splash splosh”, ”pour pour pour”, “stir stir you’re stirring”.

Offer different sized containers. This is often so powerful and keeps your child occupied for a nice long time. No need to buy anything special: just bring out your kitchen utensils and some Tupperware containers.

4. Blow bubbles

Bubbles are a fantastic way to engage children. You can play ‘stop and go’ games, take turns and practise key concepts such as ‘under – blow bubbles under my hand’. Your child can practise their expressive language, creating sentences such as ‘blowing bubbles in the pool’.

5. Draw with chalk on pavement slabs to encourage speech sound production or just general nice communication

Use chalk outside to draw a ladder. Your child can practise their speech sound production without even realising it! You can go first to model the sound if needed. Drawing anything onto the pathway with coloured chalk can be really fun.

Afterwards you can wash the pathway and again there is lots of vocabulary you could use there to help your little one practise speech sounds. For example, if your child is practising the word “YELLOW” (as many of my children do) you can draw lots of little yellow things and then name them together:

  • yellow banana
  • yellow flower
  • yellow submarine
  • yellow balloon

You get the idea!

6. Walk in nature. Comment on what you see, smell, hear and feel

Make the most of where you live. Go for a walk. You can sing songs along your walk or comment about what you see, smell, hear and feel. For example: I hear the birds, they are singing; I smell the sea and can hear the waves crashing against the rocks. Make sure your comments are appropriate for the age and stage of your child.

7. Sing songs

This is a lovely way to get your child hearing language, rhyme and rhythm. You can take turns, and fill in the missing words such as “heads, shoulders, knees and ______”.

8. Word games (such as ISpy)

The beauty of this game is that it can be played anywhere and everywhere! The importance is that these word games develop phonological awareness (the ability to hear and manipulate sounds in words).

Contact me for speech, language and communication support.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Explore activities for Gestalt Language Processors to aid communication
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Explore activities for Gestalt Language Processors to aid communication

ByLondon Speech and Feeding
Speech Therpaist in London

When you have a child who uses Gestalts it is often difficult to think and adapt clinic activities into those to use at home. More importantly, you find that individualising your activities for your child who uses Gestalt are time-consuming. But you value its importance for their communication development.

You feel so busy, you are taking them to other appointments, or trying to get through your daily activities, all whilst still ensuring your child’s emotional needs are met. You know life should not get in the way of your child’s therapy activities at home, but it does. We know your spare time is precious and limited, so let us achieve your child’s or young person’s goals in the allotted time you have which meets their way of learning (using Gestalts).

We wanted to support you by exploring items which you may have at home, and we will give you some key phrases which you can start to model with your child. Whereas our last blog introduced the idea of gestalt language processors, we are now developing ideas to give you the tools to implement activities at home. We recognise how overwhelming it may feel, and this is one of the reasons to make activities as straight forward as possible. Therapy does not need to be complicated; it just needs to be carried out on a regular basis.

Explore the samples I’ve created to give you an idea of how this might look but please consult with a Speech and Language Therapist who knows about Gestalt Language Processing so that you can work together to develop great home activities for your child.

Want to learn more about gestalt language processing?

Please contact me for help.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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How to use Attention Autism to develop language and communication
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How to use Attention Autism to develop language and communication

ByLondon Speech and Feeding

Now you’ve read Attention Autism (part one), you are familiar with the concept of ‘bucket time’ and the benefits it has to offer your child. It’s time to explore all the different stages. In sessions, it can be noisy and with so much to take in, you may want something to refer to. If you’re in need of a helping hand or memory jogger for stage two, read on…

Knowing what stage your child is working at is vital. Every stage has different aims to develop and enhance functional communication. So being familiar with your child’s goals ensures you can continue to practise at home. If you’re unsure of their goals, please ask your Speech and Language Therapist.

With all speech, language and communication goals, the aim is always to generalise skills from therapy settings to home and nursery or school life. This generalisation period will take time. Please try to stick with the plan. You will experience the benefits for your child, and it’ll make family life a little easier.

You may remember that Autistic children thrive on visuals. Let’s use their strengths to support their communication needs. It is a good idea at the start of the activity to have a visual for what’s happening now and what will happen next. If you’re anything like me, you’ll grab a pen and paper or a whiteboard and whiteboard pen, and will doodle away! You don’t need fancy photos.

On the left is a bag with Now written above it and Bag below. On the right are three children playing with Net written above and Play written below.

The attention builder

Stage two of the Attention Autism approach is called “the attention builder”. The clue is in the name, your child’s goal is to keep focused on the activity for a longer period. The duration will be different for every child, but it’s useful to time their attention, so you can report progress back to your therapist.

Parents are often worried about doing something wrong. If it all goes a bit pear-shaped or not as you expected, don’t panic! This is the time to ask yourself, did my child have fun? Did they engage in the activity? It’s very helpful to reflect on the experience. What could you do that would make the activity easier for your child to access? (For example, did you set up the activity before your child entered the room? This would allow for a smoother session, so that waiting time was minimal.)

Three ideas for stage two activities

There are so many ideas out there, which at times can feel overwhelming. I’m always looking for the easiest options to present to you to reduce overwhelm and allow it to feel manageable.

Remember this is about having fun. Your child’s communication will benefit from you relaxing and having this structured approach.

Here are our three top ideas for stage two attention Autism activities:

1. Flour castles

You’ll need:

  • Container, cup or glass
  • Flour
  • Sheet (for the table/floor) (optional)

This is a fun-filled activity to try. But it can get a little messy!

Fill a small glass, cup or container with flour and flip the cup over to build flour castles. It’s great to engage your child especially with the “Splat” at the end.

2. Paint balls

Another activity which is a little bit cleaner is ‘Paint balls’.

You’ll need:

  • Tray, container
  • Paint
  • Rubber balls or marbles
  • Paper (optional)

First dip the marbles into the paint, then drop into the container and roll it around to make a pattern. You could always make a pattern on some paper.

I love to use everyday objects in therapy, so when I came across this next idea, it was added to the list. It’s simple, effective, not to mention clean!

3. Skittles

You’ll need:

  • A packet of skittles
  • Warm water
  • Plate

You’ll need to create a circle of skittles around the edge of the plate. Then add small amounts of warm water to the plate and watch the rainbow of colours appear.

These activities offer a sequence to build and sustain your child’s attention. Remember the key is to have fun. Create meaningful interactions that your child cannot miss! If they can learn to hold their attention, they can learn to use functional skills.

Now you’ve got ideas for stage two activities. Go ahead and carry them out.

Have fun!

If you need speech, language or communication support or advice, I am always here to help.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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